Central Pain Syndrome: Symptoms, Types, Causes and Treatment

Central Pain Syndrome (CPS) is a complex and often misunderstood condition that dramatically affects the lives of those who experience it. Unlike pain that results from injury or inflammation in the body’s tissues, central pain originates from damage or dysfunction within the brain, spinal cord, or central nervous system. This unique origin means that CPS can present with a wide variety of symptoms, overlap with other pain conditions, and prove difficult to treat. In this article, we’ll explore the symptoms, types, causes, and treatments of Central Pain Syndrome, drawing on the latest scientific research to provide a comprehensive and accessible resource.

Symptoms of Central Pain Syndrome

Living with Central Pain Syndrome often means encountering a broad and sometimes bewildering spectrum of symptoms. These symptoms can range from persistent burning or aching pain to unusual sensations and hypersensitivity, and they often fluctuate in intensity. Because CPS arises from the central nervous system rather than from injuries or inflammation in the body’s periphery, its symptoms are distinct, often diffuse, and can profoundly impact mood, cognition, and quality of life.

Symptom	Description	Commonality	Source(s)
Widespread Pain	Persistent, often burning or aching pain	Very Common	1 2 3 6
Sensory Changes	Hypersensitivity, allodynia, dysesthesia	Common	1 2 7
Fatigue	Persistent tiredness, low energy	Frequent	1 2
Mood Disturbance	Anxiety, depression, irritability	Frequent	1 2
Cognitive Issues	Memory, attention, or thinking difficulties	Sometimes	1 2
Sleep Problems	Difficulty falling or staying asleep	Common	1 2

Table 1: Key Symptoms

The Spectrum of Sensations

Central Pain Syndrome doesn’t feel the same for everyone. Some people describe their pain as constant burning, stabbing, or aching sensations. Others report sharp, electric-shock-like jolts. This pain can be steady or fluctuate, sometimes triggered by touch, temperature changes, or even emotional stress. It commonly affects areas corresponding to the site of the central nervous system lesion, but in some cases, pain can be widespread, affecting multiple regions of the body 1 3 6.

Sensory Disturbances and Hypersensitivity

A hallmark of CPS is altered sensory processing. This can include:

• Allodynia: Pain from stimuli that shouldn’t cause pain, like light touch or even clothing.
• Hyperalgesia: Exaggerated response to painful stimuli.
• Dysesthesia: Unpleasant, abnormal sensations such as tingling, crawling, or numbness 1 6 7.

These symptoms are due to the central nervous system’s impaired ability to process sensory information accurately after injury or disease.

Fatigue, Mood, and Cognitive Symptoms

Pain is rarely the only problem. Many people with CPS also struggle with:

• Persistent fatigue and low energy
• Mood imbalances, including depression and anxiety
• Cognitive issues, such as poor concentration or memory lapses
• Sleep disturbances, which further exacerbate other symptoms 1 2

These symptoms can form a vicious cycle, with pain disrupting sleep and mood, while poor sleep and mood further intensify the perception of pain.

Types of Central Pain Syndrome

Central Pain Syndrome is an umbrella term covering several distinct clinical conditions. Although all share an origin in central nervous system dysfunction, the specific features and causes can vary widely depending on the underlying disease or injury.

Type	Origin/Location	Typical Features	Source(s)
Central Post-Stroke Pain	Follows stroke (brain lesion)	Delayed onset, localized	3 4 5 6
Spinal Cord Injury Pain	Lesion in spinal cord	Below injury level, diffuse	3 4 5 6
Multiple Sclerosis Pain	CNS demyelination (brain/spinal cord)	Mixed symptoms	3 5 6
Other CPS (e.g. TBI)	Brain injury, tumors, infections	Variable	3 4 6

Table 2: Central Pain Syndrome Types

Central Post-Stroke Pain

This is the most prevalent form of CPS worldwide. It typically develops weeks to months after a stroke, manifesting as pain and sensory disturbances in the area of the body affected by the stroke. Patients may experience burning, aching, or shooting pain, often accompanied by heightened sensitivity to touch or temperature 3 4 5 6.

Spinal Cord Injury-Related Pain

Individuals with spinal cord injury (SCI) are at the highest risk for developing central neuropathic pain. This pain frequently affects regions below the level of injury and can be extremely difficult to manage. It often presents as burning or tingling, sometimes with episodes of severe shooting pain 3 4 5 6.

Multiple Sclerosis-Related Pain

Multiple sclerosis (MS) can cause lesions throughout the central nervous system, leading to a variety of pain syndromes. MS-related central pain may present as ongoing burning sensations, facial pain (trigeminal neuralgia), or paroxysmal pain attacks, often fluctuating with disease activity 3 5 6.

Other Forms

CPS can also arise from other causes, such as traumatic brain injury, tumors, or certain infections that damage the central nervous system. These forms tend to be more variable in their presentation and depend on the precise location and nature of the injury 3 4 6.

Causes of Central Pain Syndrome

The development of Central Pain Syndrome is rooted in complex changes within the central nervous system. These changes can be triggered by a variety of diseases or injuries, leading to maladaptive processing of pain signals.

Cause	Mechanism	Common Triggers	Source(s)
CNS Lesion	Damage to brain or spinal cord pathways	Stroke, SCI, MS	3 4 5 6 8
Neuroinflammation	Activation of glial cells, cytokine release	Injury, disease	7 8
Central Sensitization	Increased neuronal responsiveness	Chronic pain, stress	1 2 7 9
Maladaptive Plasticity	Abnormal rewiring, hyperexcitability	CNS injury	6 7 8

Table 3: Causes and Mechanisms

CNS Lesions and Disease

CPS is fundamentally caused by a lesion or disease affecting the somatosensory pathways of the brain or spinal cord. This can result from:

• Stroke: Infarcts or hemorrhages disrupting sensory pathways.
• Spinal Cord Injury: Trauma or disease damaging spinal tracts.
• Multiple Sclerosis: Demyelination and neuroinflammation.
• Other CNS Disorders: Tumors, infections, traumatic brain injury 3 4 5 6 8.

Central Sensitization

A major contributor to CPS is "central sensitization"—a state where neurons in the central nervous system become hyper-responsive. This means that normal sensory inputs (even gentle touch) can be perceived as painful, and painful stimuli feel even worse. Central sensitization can develop after repeated pain signals, chronic stress, or ongoing inflammation 1 2 7 9.

Neuroinflammation

Neuroinflammation is the activation of immune-like glial cells in the CNS, leading to the release of pro-inflammatory cytokines and chemokines. This process can:

• Amplify pain signaling pathways
• Induce or worsen central sensitization
• Sustain chronic pain even in the absence of ongoing injury 7 8

Maladaptive Plasticity

Following injury, the nervous system attempts to rewire itself. Sometimes, this adaptation goes awry, leading to:

• Neuronal hyperexcitability
• Disruption of normal inhibitory pathways
• Aberrant signaling in pain circuits 6 7 8

These mechanisms explain why CPS can persist long after the initial injury and why it can be so challenging to treat.

Treatment of Central Pain Syndrome

Managing Central Pain Syndrome is a significant clinical challenge. No single treatment works for everyone, and effective relief often requires a personalized, multimodal approach that combines medications, non-pharmacological therapies, and patient education.

Treatment	Approach/Modality	Effectiveness/Role	Source(s)
Antidepressants	TCAs, SNRIs	First-line, moderate efficacy	4 5 6 9
Gabapentinoids	Gabapentin, Pregabalin	First-line, moderate efficacy	4 5 6 9
Other Medications	Opioids, AEDs, Lidocaine	Limited/variable efficacy	4 5 6
Non-Pharmacologic	Exercise, CBT, education	Important adjunct, emerging	2 4 6 9
Neuromodulation	TMS, spinal cord stim	Refractory cases	4 5 6

Table 4: Treatment Strategies

Pharmacological Treatments

The mainstays of pharmacological treatment include:

• Tricyclic Antidepressants (TCAs): Amitriptyline is often used for its ability to modulate pain pathways.
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): These can help by enhancing endogenous pain inhibition.
• Gabapentinoids: Gabapentin and pregabalin target neuronal excitability and are considered first-line treatments 4 5 6 9.

Other drugs, such as certain antiepileptics (lamotrigine), intravenous lidocaine, and opioids, may be used, but evidence for their effectiveness is mixed and they often carry significant side effects 4 5 6.

Non-Pharmacological Interventions

Non-drug therapies are increasingly recognized as vital components of CPS management:

• Exercise Therapy: Gradual, tailored physical activity can reduce pain and improve function.
• Cognitive Behavioral Therapy (CBT): Helps patients manage the psychological impact of chronic pain and can directly reduce pain perception 2 6 9.
• Pain Neuroscience Education: Teaching patients about the biology of pain reduces fear and can improve outcomes.
• Sleep and Stress Management: Addressing these factors can reduce overall pain burden 9.

Neuromodulation and Emerging Therapies

For patients with refractory CPS, neuromodulatory approaches may offer relief:

• Transcranial Magnetic Stimulation (TMS): Non-invasive brain stimulation can modulate pain circuits.
• Spinal Cord Stimulation: Implanted devices deliver electrical impulses to disrupt pain signaling 4 5 6.

Research into targeting neuroinflammation (e.g., glial cell modulators), P2X receptor antagonists, and other novel approaches is ongoing and holds promise for future treatments 7 8.

Multimodal and Individualized Care

Given the complexity of CPS, effective management usually means:

• Combining medications with non-pharmacological strategies
• Tailoring the plan to the individual’s symptoms and circumstances
• Focusing on long-term improvement rather than quick fixes 6 9

Conclusion

Central Pain Syndrome is a challenging, multifaceted condition that arises from dysfunction within the central nervous system. It presents with a range of symptoms, can emerge from several types of CNS injury or disease, and is driven by complex mechanisms like central sensitization and neuroinflammation. Treatment is often difficult, but a combination of medication, non-pharmacologic strategies, and individualized care offers hope for improved quality of life.

Key takeaways:

• Central Pain Syndrome symptoms include widespread pain, sensory disturbances, fatigue, mood and cognitive changes, and sleep disruption 1 2 3 6.
• Main types include central post-stroke pain, spinal cord injury pain, and multiple sclerosis-related pain, each with unique features 3 4 5 6.
• Causes center on CNS lesions, central sensitization, neuroinflammation, and maladaptive neural plasticity 3 4 5 6 7 8 9.
• Treatment requires a multimodal approach, combining medications (antidepressants, gabapentinoids), non-drug therapies (exercise, CBT), and, in some cases, neuromodulation 2 4 5 6 9.
• Ongoing research into the mechanisms and new therapies for CPS continues to improve prospects for affected individuals.

If you or someone you know is struggling with chronic, unexplained pain following a neurological event, consult a healthcare provider familiar with central pain syndromes for thorough evaluation and a tailored treatment plan.